A Daughter's Journal

Homeward Bound

by Ann D. Gross

At night at home in New York, I couldn't sleep because I felt sad about my Mom still living in a skilled nursing (SNF) facility. Ninety days of supposed "rehab" had turned into five months and counting.

I thought back four months when I visited her in Florida. Her Clostridium difficile infection had recurred, and she had become extremely sick with the intestinal monster. She was moved from her cozy room at the SNF to a hospital for three days. I was grateful that I happened to be there when she really needed me.

At the hospital, she was disoriented and frightened. By mistake, Mom's doctor had ordered the very antibiotic to treat her urinary tract infection that had sent her into the downward spiral of the C. diff. in the first place three months earlier. After Mom took the antibiotic her doctor had prescribed (Mom is from the generation that doesn't question The Doctor), the C. diff returned with a vengeance.

Singing Away the C. diff Blues

I sat at Mom's bedside in the hospital, furious with the doctor, but trying to comfort her. Then, in the smallest, weakest voice, she began to sing, "I could have danced all night, I could have danced all night, and still have begged for more."

I chimed in with her. There we were together in the middle of her large hospital room croaking out a song about dancing all night. (Mom had to be isolated because C. diff has a nasty way of jumping from hospital patient to hospital patient.)

It was one of the most poignant moments of her illness and convalescence. The two of us, bound by blood, genes, and the eternal struggle between mothers and daughters, singing away the awful reality. We transformed her into Eliza Doolittle, home from the ball where she successfully transcended sorry beginnings and passed herself off as a princess.

I truly believed that maybe she would dance all night--someday soon. But for the moment, I pulled the lid off the orange sherbet and spoon-fed her the watery pink stuff and her bedtime meds. She hummed a bit more and then started again, "I could have spread my wings, and done a thousand things, I've never done before... ."

I chimed in with her through the rest of the lyrics, and then Mom began talking about seeing my Dad, who died three years ago. I realized then that we had a long way to go.

Hospital Versus SNF

That hospital incident occurred four months ago. When Mom was discharged, she was genuinely glad to return to her own room at the SNF. There, she could get the care she needed in her newly weakened state. More than ever, she now appreciates the SNF's personal touches as compared with the hospital's brutal anonymity. But she's also inconsolable, crying frequently. She laments that, just as she had built up her strength by working hard with her therapists at the SNF for three long months, she has to start from scratch.

She's right, but I can't let her know that. I can't even admit it to myself. My family makes doomsday pronouncements of how she'll never get back home. I practice my best skill--denying reality--and refuse to participate in their realistic assessments. I avoid her doctor and his somber head-shaking about Mom's condition. I secretly cheer when the social worker at the SNF complains that Mom is difficult. "You go girl," I think, while apologizing and sometimes even commiserating with the social worker to win her over to our side.

Work Begins--Again

Over the next few weeks, Mom begins to work harder at her physical therapy than she has ever worked before. She becomes an athlete in training. She has two physical therapy sessions a day--one in the morning, one in the afternoon. In between, she pushes herself to eat whatever is nutritious on her room-service tray and naps to prepare for her next training session.

I make a quick trip to see her the month after she returns to the SNF from the hospital. In my observation, our refusal to "face the facts" (like everyone else had done with all the requisite head-shaking) has paid off handsomely.

Careful What You Wish For

I enter the therapy room and find a beaming physical therapist, Carol, whom I playfully call the drill sergeant.

"Annie!" Mom greets me, thrilled that I'm seeing her in a setting where she's competent and praiseworthy. "Look what I can do."

Mom marches herself over to what looks like a wooden labyrinth stretching along the wall of the far side of the room. It comprised squares and rectangles of different shapes, some of which stretch over a ramp. Mom goes to the beginning of the obstacle course with only a cane in hand and navigates it as if she were a member of the "Lord of the Dance" troupe. She finishes to the claps and cheers of Carol and her fellow physical therapists Kathy and Helen.

Meanwhile, residents and other therapists have watched Mom's nimble show. We all break out in hoots and hollers. Carol and Kathy have tears streaming down their faces.

"I told all those doctors," Mom pronounces proudly. "I'm doing great!"

Carol and Kathy walk up to me, still teary-eyed. "I can't believe the progress she's made," says Carol. "It's miraculous. The doctor is talking about sending her home at the end of the month."

Mom, Carol, Kathy, and I stand there, taking in what Carol just said. We stagger with the news. Mom beams, proud of herself for the first time since she's been at the SNF. And then she inches closer to Kathy. "You guys," I say, "we owe it all to you."

"We sure do," Mom chimes in. "They worked me hard each day. They're my good friends!"

"I told you, you don't belong here," chirps Kathy. "We'll just have to get together with you outside of this place."

Mom always wanted to believe she was at the SNF "strictly for rehab"--even in the darkest, sickest, most incapacitated hours when she was confined to a wheelchair. It really was touch-and-go for a long time, made more touch and less go by her re-hospitalization with the recurrence of C. diff.

New Attitudes

From that moment on, I bore witness to one of the stranger phenomena I've ever seen, although it now makes perfect sense to me.

"I have a new attitude," Mom proclaims to her beloved PTs and me. "I'm no longer going to be negative."

This from my Mom, who from the day she was wheeled into the SNF until this very moment has complained bitterly and ceaselessly: "They wake me up too early. The food is awful. The CNAs are mean to me. They only let me shower twice a week. They never help me at night. They never come when I ring the button."

All of a sudden, Mom begins talking about the SNF as if it were a vacation spa filled with her dear friends that she can't bear to leave.

"You know, this is a wonderful place," Mom says to me.

"Yes, Mom, I've always thought so. And we're so lucky that there was space for you to come here and get the care you needed to get strong."

We are still in the therapy room, surrounded by Mom's proud PTs, including the drill sergeant. "Well," Mom says, "I think I'll start making time to go to the activities. You know there are many activities here, and they're wonderful! I think I'll start going to beading classes tomorrow. I've never had the time before."

"I don't know if you'll still have time," says Carol. "The doctor is talking about sending you home at the end of the month, and we have to get you ready."

Mom looks like a little girl who is being punished. "We'll see," she says, teetering a bit. "I think I'm tired and I want to get back into my wheelchair. I think it may take a bit longer than a month.

"If I'm going to go back home, we have to make sure I'm strong enough to live all by myself," she says. "After all, I'm used to all the action around here. I may not do well at home all by myself."

I stand there listening to her say "by myself" twice in a row, suddenly hearing her ambivalence about leaving a place to which she has worked so hard to adapt herself.

I immediately kick into my gerontologist mode, reminding myself to check the literature about nursing home residents' ambivalence about being discharged back to their community-dwelling lives, especially when they are widowed. I'm already planning my PubMed search, because as a daughter, I am too overwhelmed by it all.

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